Maurizio Zibetti1, Elena Moro2, Vibhor Krishna3, Francesco Sammartino3, Marina Picillo4, Renato P Munhoz5, Andres M Lozano3, Alfonso Fasano6. 1. Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy. 2. Service de Neurologie, CHU Grenoble, Joseph Fourier University, INSERM U836, Grenoble, France. 3. Division of Neurosurgery, Toronto Western Hospital - UHN, University of Toronto, Toronto, Ontario, Canada. 4. Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno, Salerno, Italy. 5. Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. 6. Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada. Electronic address: alfonso.fasano@uhn.ca.
Abstract
BACKGROUND: Parkinson's disease patients undergoing subthalamic nucleus deep brain stimulation (STN DBS) at standard frequency (>100 Hz) often develop gait impairment, postural instability and speech difficulties. Low frequency stimulation (<100 Hz, LFS) can improve such axial symptoms, but there are concerns that improvement may be transient. OBJECTIVE: To identify long-term outcome and predictors of low-frequency subthalamic stimulation in Parkinson's disease. METHODS: Through a chart review we identified 85 out of 324 STN DBS patients who received a trial of LFS and describe their characteristics and outcome predictors. RESULTS: Patients were switched to LFS (<100 Hz) 3.8 ± 3.3 years after surgery. Most patients (64%) attained a subjective improvement of gait, speech or balance for 2.0 ± 1.9 years. Motor scores improved within the first year after the stimulation change and showed a slower progression over time when compared to patients switched back to high frequency stimulation. UPDRS III axial score on medication before surgery and the y-axis coordinate of the active contact were independent predictors of LFS retention. CONCLUSIONS: This report provides evidence that the use of LFS yields an enduring benefit in a considerable percentage of patients who develop axial motor symptoms during conventional stimulation.
BACKGROUND:Parkinson's diseasepatients undergoing subthalamic nucleus deep brain stimulation (STN DBS) at standard frequency (>100 Hz) often develop gait impairment, postural instability and speech difficulties. Low frequency stimulation (<100 Hz, LFS) can improve such axial symptoms, but there are concerns that improvement may be transient. OBJECTIVE: To identify long-term outcome and predictors of low-frequency subthalamic stimulation in Parkinson's disease. METHODS: Through a chart review we identified 85 out of 324 STN DBSpatients who received a trial of LFS and describe their characteristics and outcome predictors. RESULTS:Patients were switched to LFS (<100 Hz) 3.8 ± 3.3 years after surgery. Most patients (64%) attained a subjective improvement of gait, speech or balance for 2.0 ± 1.9 years. Motor scores improved within the first year after the stimulation change and showed a slower progression over time when compared to patients switched back to high frequency stimulation. UPDRS III axial score on medication before surgery and the y-axis coordinate of the active contact were independent predictors of LFS retention. CONCLUSIONS: This report provides evidence that the use of LFS yields an enduring benefit in a considerable percentage of patients who develop axial motor symptoms during conventional stimulation.
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Authors: Adolfo Ramirez-Zamora; James J Giordano; Aysegul Gunduz; Peter Brown; Justin C Sanchez; Kelly D Foote; Leonardo Almeida; Philip A Starr; Helen M Bronte-Stewart; Wei Hu; Cameron McIntyre; Wayne Goodman; Doe Kumsa; Warren M Grill; Harrison C Walker; Matthew D Johnson; Jerrold L Vitek; David Greene; Daniel S Rizzuto; Dong Song; Theodore W Berger; Robert E Hampson; Sam A Deadwyler; Leigh R Hochberg; Nicholas D Schiff; Paul Stypulkowski; Greg Worrell; Vineet Tiruvadi; Helen S Mayberg; Joohi Jimenez-Shahed; Pranav Nanda; Sameer A Sheth; Robert E Gross; Scott F Lempka; Luming Li; Wissam Deeb; Michael S Okun Journal: Front Neurosci Date: 2018-01-24 Impact factor: 4.677